Failure to Honor Discharge Appeal and Document Discharge Planning
Penalty
Summary
Surveyors identified that the facility failed to allow a resident to remain in the facility during a pending discharge appeal. The resident was admitted with diagnoses including orthopedic aftercare following surgical amputation, other acute osteomyelitis of the left ankle and foot, COPD, and muscle weakness, and had a care plan goal to return home with family once able to verbalize needed assistance and required services post-discharge. The care plan directed Social Services to encourage the resident to discuss concerns impeding discharge, establish a pre-discharge plan, and arrange community resources to support independence after discharge. A PT discharge summary covering the stay indicated the plan was for the resident to discharge home at the highest practical level with recommended home health services, but the summary did not document whether those home health services were actually arranged prior to discharge. A DCF appeal hearing form showed that an appeal of the discharge was filed based on the resident’s belief that they were being erroneously discharged from the facility. The resident’s electronic medical record contained no documentation that the resident or representative had filed an appeal, no notes explaining why the resident might not have been ready for discharge, no AHCA discharge/transfer form, and no documented discharge summary. The SSD, newly employed and unfamiliar with the case, confirmed the absence of any appeal-related documentation and required discharge forms in the record. The NHA stated that Social Services is responsible for discussing discharges, completing assessments, and documenting discharge notes, and acknowledged that if a resident files an appeal, they should not be discharged until after the appeal decision, but also acknowledged that coverage gaps in Social Services led to discharge processes not being completed correctly. The facility’s discharge planning policy required a process focused on resident discharge goals, support system, and transition timing to ensure a smooth process, which was not reflected in the documentation for this resident.
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